Surgical staple cartridge with self-dispensing staple buttress

ABSTRACT

A surgical instrument includes a handle portion, a shaft housing a firing bar, an end effector comprising an anvil, a lower jaw, and a stapling and severing assembly responsive to a longitudinal closing motion produced by the handle portion and the shaft. The lower jaw is configured to receive a removable cartridge when in an open position. The cartridge includes a housing, a plurality of staples disposed in the housing, and a deck disposed over the plurality of staples. The deck defines apertures, with each aperture being substantially disposed over each staple. The instrument includes a movable buttress that is integral with the housing of the cartridge or integral with the lower jaw of the end effector. The buttress may attach to the anvil and include a portion to receive tissue. The receipt of tissue urges and moves the buttress proximally inwards to further encompass the tissue.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through a cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasound, RF, laser,etc.). Endoscopic surgical instruments may include a shaft between theend effector and a handle portion, which is manipulated by theclinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in; U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,964,363, entitled “Surgical Stapling Instrument havingArticulation Joint Support Plates for Supporting a Firing Bar,” issuedNov. 15, 2005; U.S. Pat. No. 6,978,921, entitled “Surgical StaplingInstrument Incorporating an E-Beam Firing Mechanism,” issued Dec. 27,2005; U.S. Pat. No. 6,988,649, entitled “Surgical Stapling InstrumentHaving a Spent Cartridge Lockout,” issued Jan. 24, 2006; U.S. Pat. No.7,000,818, entitled “Surgical Stapling Instrument Having SeparateDistinct Closing and Firing Systems,” issued Feb. 21, 2006; U.S. Pat.No. 7,111,769, entitled “Surgical Instrument Incorporating anArticulation Mechanism having Rotation about the Longitudinal Axis,”issued Sep. 26, 2006; U.S. Pat. No. 7,143,923, entitled “SurgicalStapling Instrument Having a Firing Lockout for an Unclosed Anvil,”issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled “SurgicalStapling Instrument Incorporating a Multi-Stroke Firing Mechanism with aFlexible Rack,” issued Dec. 4, 2007; U.S. Pat. No. 7,367,485, entitled“Surgical Stapling Instrument Incorporating a Multistroke FiringMechanism Having a Rotary Transmission,” issued May 6, 2008; U.S. Pat.No. 7,380,695, entitled “Surgical Stapling Instrument Having a SingleLockout Mechanism for Prevention of Firing,” issued Jun. 3, 2008; U.S.Pat. No. 7,380,696, entitled “Articulating Surgical Stapling InstrumentIncorporating a Two-Piece E-Beam Firing Mechanism,” issued Jun. 3, 2008;U.S. Pat. No. 7,404,508, entitled “Surgical Stapling and CuttingDevice,” issued Jul. 29, 2008; U.S. Pat. No. 7,434,715, entitled“Surgical Stapling Instrument having Multistroke Firing with OpeningLockout,” issued Oct. 14, 2008; U.S. Pat. No. 7,721,930, entitled“Disposable Cartridge with Adhesive for Use with a Stapling Device,”issued May 25, 2010; and U.S. Pat. No. 7,455,208, entitled “SurgicalInstrument with Articulating Shaft with Rigid Firing Bar Supports,”issued Nov. 25, 2008. The disclosure of each of the above-cited U.S.patents is incorporated by reference herein. While the surgical staplersreferred to above are described as being used in endoscopic procedures,it should be understood that such surgical staplers may also be used inopen procedures and/or other non-endoscopic procedures.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1A depicts a perspective view of an articulating surgicalinstrument with an end effector in a nonarticulated position;

FIG. 1B depicts a perspective view of the surgical instrument of FIG. 1Awith an end effector in an articulated position;

FIG. 2 depicts a perspective view of an opened end effector of thesurgical instrument of FIGS. 1A-1B;

FIG. 3A depicts a side cross-sectional view of the end effector of FIG.2, taken along line 3-3 of FIG. 2, with the firing bar in a proximalposition;

FIG. 3B depicts a side cross-sectional view of the end effector of FIG.2, taken along line 3-3 of FIG. 2, but showing the firing bar in adistal position;

FIG. 4 depicts an end cross-sectional view of the end effector of FIG.2, taken along line 4-4 of FIG. 2;

FIG. 5 depicts an exploded perspective view of the end effector of FIG.2;

FIG. 6 depicts a perspective view of the end effector of FIG. 2,positioned at tissue and having been actuated once in the tissue;

FIG. 7A depicts a perspective, fragmentary view of a cartridge of theend effector of FIG. 2 including an exemplary integral self-dispensingbuttress, the buttress in a first, retracted position in which it isunattached to the anvil;

FIG. 7B depicts a perspective, fragmentary view of the buttress of FIG.7A in a second, extended position in which it is attached to the anvil;

FIG. 8 depicts a perspective, fragmentary view of a cartridge of the endeffector of FIG. 2 including another exemplary integral self-dispensingbuttress, the buttress in an open position in which it is attached tothe anvil;

FIG. 9 depicts a perspective, fragmentary exploded view of a lower jawof the end effector of FIG. 2 including another exemplary integralself-dispensing buttress, the buttress in an open position in which itis attached to the anvil;

FIG. 10 depicts a elevation view of the end effector of FIG. 2 includingthe buttress of FIG. 9 in which tissue is received within anintermediate portion of the buttress to push the buttress proximallyinto a space between the cartridge and the anvil of the end effector;and

FIG. 11 depicts a perspective view of an end effector with an integralself-dispensing buttress, the end effector positioned at and actuatedwithin the tissue to release a tissue repair composition from thebuttress onto the tissue.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. Exemplary Surgical Stapler

FIGS. 1-6 depict an exemplary surgical stapling and severing instrument(10) that is sized for insertion, in a nonarticulated state as depictedin FIG. 1A, through a trocar cannula passageway to a surgical site in apatient for performing a surgical procedure. Surgical and stapling andsevering instrument (10) includes handle portion (20) connected toimplement portion (22), the latter further comprising shaft (23)distally terminating in an articulating mechanism (11) and a distallyattached end effector (12). Once articulation mechanism (11) anddistally end effector (12) are inserted through the cannula passagewayof a trocar, articulation mechanism (11) may be remotely articulated, asdepicted in FIG. 1B, by articulation control (13). Thereby, end effector(12) may reach behind an organ or approach tissue from a desired angleor for other reasons. It should be understood that terms such as“proximal” and “distal” are used herein with reference to a cliniciangripping handle portion (20) of instrument (10). Thus, end effector (12)is distal with respect to the more proximal handle portion (20). It willbe further appreciated that for convenience and clarity, spatial termssuch as “vertical” and “horizontal” are used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these terms are not intended to be limiting andabsolute.

End effector (12) of the present example includes a lower jaw (16) and apivotable anvil (18). Handle portion (20) includes pistol grip (24)toward which closure trigger (26) is pivotally drawn by the clinician tocause clamping, or closing, of the anvil (18) toward lower jaw (16) ofend effector (12). Such closing of anvil (18) is provided through anoutmost closure sleeve (32), which longitudinally translates relative tohandle portion (20) in response to pivoting of closure trigger (26)relative to pistol grip (24). A distal closure ring (33) of closuresleeve (32) is indirectly supported by frame (34) of implement portion(22). At articulation mechanism (11), a proximal closure tube (35) ofclosure sleeve (32) communicates with the distal portion (closure ring)(33). Frame (34) is flexibly attached to lower jaw (16) via articulationmechanism (11), enabling articulation in a single plane. Frame (34) alsolongitudinally slidingly supports a firing drive member (not shown) thatextends through shaft (23) and communicates a firing motion from firingtrigger (28) to firing bar (14). Firing trigger (28) is farther outboardof closure trigger (26) and is pivotally drawn by the clinician to causethe stapling and severing of clamped tissue in end effector (12), aswill be described in greater detail below. Thereafter, release button(30) is depressed to release the tissue from end effector (12).

FIGS. 2-5 depict end effector (12) employing an E-beam firing bar (14)to perform a number of functions. As best seen in FIGS. 3A-3B, firingbar (14) includes a transversely oriented upper pin (38), a firing barcap (44), a transversely oriented middle pin (46), and a distallypresented cutting edge (48). Upper pin (38) is positioned andtranslatable within an anvil pocket (40) of anvil (18). Firing bar cap(44) slidably engages a lower surface of lower jaw (16) by having firingbar (14) extend through channel slot (45) (shown in FIG. 3B) that isformed through lower jaw (16). Middle pin (46) slidingly engages a topsurface of lower jaw (16), cooperating with firing bar cap (44).Thereby, firing bar (14) affirmatively spaces end effector (12) duringfiring, overcoming pinching that may occur between anvil (18) and lowerjaw (16) with a minimal amount of clamped tissue and overcoming staplemalformation with an excessive amount of clamped tissue.

FIG. 2 shows firing bar (14) proximally positioned and anvil (18)pivoted to an open position, allowing an unspent staple cartridge (37)to be removably installed into a channel of lower jaw (16). As best seenin FIGS. 4-5, staple cartridge (37) of this example includes a cartridgebody (70), which presents an upper deck (72) and is coupled with a lowercartridge tray (74). As best seen in FIG. 2, a vertical slot (49) isformed through part of staple cartridge (37). As also best seen in FIG.2, three rows of staple apertures (51) are formed through upper deck(70) on one side of vertical slot (49), with another set of three rowsof staple apertures (51) being formed through upper deck (70) on theother side of vertical slot (49). Referring back to FIGS. 3-5, a wedgesled (41) and a plurality of staple drivers (43) are captured betweencartridge body (70) and tray (74), with wedge sled (41) being locatedproximal to staple drivers (43). Wedge sled (41) is movablelongitudinally within staple cartridge (37); while staple drivers (43)are movable vertically within staple cartridge (37). Staples (47) arealso positioned within cartridge body (70), above corresponding stapledrivers (43). In particular, each staple (47) is driven verticallywithin cartridge body (70) by a staple driver (43) to drive staple (47)out through an associated staple aperture (51). As best seen in FIGS.3A-3B and 5, wedge sled (41) presents inclined cam surfaces that urgestaple drivers (43) upwardly as wedge sled (41) is driven distallythrough staple cartridge (37).

With end effector (12) closed as depicted in FIG. 3A, firing bar (14) isadvanced in engagement with anvil (18) by having upper pin (38) enter alongitudinal anvil slot (42). A pusher block (80) is located at thedistal end of firing bar (14), and is configured to engage wedge sled(41) such that wedge sled (41) is pushed distally by pusher block (80)as firing bar (14) is advanced distally through staple cartridge (37).During such firing, cutting edge (48) of firing bar (14) enters verticalslot (49) of staple cartridge (37), severing tissue clamped betweenstaple cartridge (37) and anvil (18). As shown in FIGS. 3A-3B, middlepin (46) and pusher block (80) together actuate staple cartridge (37) byentering into a firing slot within staple cartridge (37), driving wedgesled (41) into upward camming contact with staple drivers (43) that inturn drive staples (47) out through staple apertures (51) and intoforming contact with staple forming pockets (53) on the inner surface ofanvil (18). FIG. 3B depicts firing bar (14) fully distally translatedafter completing severing and stapling tissue.

FIG. 6 shows end effector (12) having been actuated through a singlestroke through tissue (90). As shown, cutting edge (48) has cut throughtissue (90), while staple drivers (43) have driven three alternatingrows of staples (47) through the tissue (90) on each side of the cutline produced by cutting edge (48). Staples (47) are all orientedsubstantially parallel to the cut line in this example, though it shouldbe understood that staples (47) may be positioned at any suitableorientations. In the present example, end effector (12) is withdrawnfrom the trocar after the first stroke is complete, spent staplecartridge (37) is replaced with a new staple cartridge, and end effector(12) is then again inserted through the trocar to reach the staplingsite for further cutting and stapling. This process may be repeateduntil the desired amount of cuts and staples (47) have been provided.Anvil (18) may need to be closed to facilitate insertion and withdrawalthrough the trocar; and anvil (18) may need to be opened to facilitatereplacement of staple cartridge (37).

It should be understood that cutting edge (48) may sever tissuesubstantially contemporaneously with staples (47) being driven throughtissue during each actuation stroke. In the present example, cuttingedge (48) just slightly lags behind driving of staples (47), such that astaple (47) is driven through the tissue just before cutting edge (48)passes through the same region of tissue, though it should be understoodthat this order may be reversed or that cutting edge (48) may bedirectly synchronized with adjacent staples. While FIG. 6 shows endeffector (12) being actuated in two layers (92, 94) of tissue (90), itshould be understood that end effector (12) may be actuated through asingle layer of tissue (90) or more than two layers (92, 94) of tissue.It should also be understood that the formation and positioning ofstaples (47) adjacent to the cut line produced by cutting edge (48) maysubstantially seal the tissue at the cut line, thereby reducing orpreventing bleeding and/or leaking of other bodily fluids at the cutline. Various suitable settings and procedures in which instrument (10)may be used will be apparent to those of ordinary skill in the art inview of the teachings herein.

It should be understood that instrument (10) may be configured andoperable in accordance with any of the teachings of U.S. Pat. No.4,805,823; U.S. Pat. No. 5,415,334; U.S. Pat. No. 5,465,895; U.S. Pat.No. 5,597,107; U.S. Pat. No. 5,632,432; U.S. Pat. No. 5,673,840; U.S.Pat. No. 5,704,534; U.S. Pat. No. 5,814,055; U.S. Pat. No. 6,964,363;U.S. Pat. No. 6,978,921; U.S. Pat. No. 6,988,649; U.S. Pat. No.7,000,818; U.S. Pat. No. 7,111,769; U.S. Pat. No. 7,143,923; U.S. Pat.No. 7,303,108; U.S. Pat. No. 7,367,485; U.S. Pat. No. 7,380,695; U.S.Pat. No. 7,380,696; U.S. Pat. No. 7,404,508; U.S. Pat. No. 7,434,715;U.S. Pat. No. 7,721,930; and/or U.S. Pat. No. 7,455,208. As noted above,the disclosures of each of those patents are incorporated by referenceherein. Additional exemplary modifications that may be provided forinstrument (10) will be described in greater detail below. Varioussuitable ways in which the below teachings may be incorporated intoinstrument (10) will be apparent to those of ordinary skill in the art.Similarly, various suitable ways in which the below teachings may becombined with various teachings of the patents cited herein will beapparent to those of ordinary skill in the art. It should also beunderstood that the below teachings are not limited to instrument (10)or devices taught in the patents cited herein. The below teachings maybe readily applied to various other kinds of instruments, includinginstruments that would not be classified as surgical staplers. Variousother suitable devices and settings in which the below teachings may beapplied will be apparent to those of ordinary skill in the art in viewof the teachings herein.

II. Exemplary Self-Dispensing Buttress Integral with a Cartridge

FIGS. 7A-7B show an exemplary self-dispensing buttress (100) integral tocartridge (37). FIG. 7A shows buttress (100) in a first, retractedposition in which buttress (100) is not yet attached to anvil (18) and aretained portion of buttress (100) is housed in cartridge (37). FIG. 7Bshows buttress (100) in a second, extended position in which buttress(100) has been attached to anvil (18) and an exposed portion of buttress(100) is available for receipt of tissue (90), as described below.

As shown in FIG. 7A, buttress (100) may be disposed within the body ofcartridge (37) above cartridge pan (102) in a rolled formation such asbuttress roll (103). Roll (103) is disposed near a distal end ofcartridge (37). Buttress (100) includes a fastener, such as T-shapedfastener (104), which is attachable to opening (106) defined in acorresponding distal end of anvil (18). Opening (106) is sized forreceipt of fastener (104). Fastener (104) includes elongate portion(108) that is disposed adjacent exterior top surface (110) of cartridge(37) in the retracted position shown in FIG. 7A. End (112) of buttress(100) is attached to elongate portion (108). End (112) extends throughan aperture (not shown) defined in cartridge (37), the aperture having ashape that corresponds to and is slightly larger than end (112). Such ashape of the aperture allows buttress (100) to be removed from cartridge(37) as described below. While elongate portion (108) is shown to have awidth substantially similar to the width of exterior top surface (110),the width of elongate portion (108) may alternatively be greater or lessthan the width of exterior top surface (110) of cartridge (37).

Intermediate portion (114) projects from elongated portion (108) in thedirection of arrow (A) toward anvil (18). Triangular portion (116)projects from intermediate portion (114) in the direction of arrow (A).Walls of the corresponding distal end of anvil (18), and particularly ata distal end of anvil slot (42) as shown in FIG. 3A, define opening(106). Opening (106) includes first portion (118) sized for receipt ofintermediate portion (114) and second portion (120) sized for receipt oftriangular portion (116). Portions (114, 116) of fastener (104) may bereceived in respective portions (118, 120) in, for example, a snap-fitconnection. Portions (114, 116) may be positioned adjacent respectiveportions (118, 120) and pressed into place in a snap-fit connection toattach fastener (104) to anvil (18) via opening (106). Fastener (104)may comprise a variety of shapes, and opening (106) may comprise avariety of corresponding shapes sized to receive fastener (104), suchthat fastener (104) and opening (106) are operable to removably securefastener (104) to anvil (18). To attach fastener (104) to anvil (18),fastener (104) may be urged upwards towards anvil (18) in the directionof arrow (A) and secured within opening (106). Alternatively oradditionally, anvil (18) may be directed downwards in the direction ofarrow (B) towards cartridge (37) to a position at which fastener (104)may be secured within opening (106). For example, closure trigger (26)may be actuated before insertion of end effector (12) into a trocar, ina manner as described above, such that closure sleeve (32)longitudinally translates with respect to handle portion (20) to closeanvil (18) toward lower jaw (16) of end effector (12). After attachmentto buttress (100), anvil (18) will be directed in the direction of arrow(A) towards an initial, open position, as shown in FIG. 7B. As anvil(18) is directed towards the initial, open position, buttress (100) willunwrap from roll (103) and be moved or urged upwards in the direction ofarrow (C). In particular, end (112) of buttress (100) is attached tofastener (104), which provides a force upon buttress (100) when fastener(104) is directed upwards in the direction of arrow (B).

Continuing to refer to FIG. 7B, when buttress (100) is attached to anvil(18) via fastener (104), buttress (100) may receive a material, such astissue (90). Tissue (90) may urge buttress (100) proximally inwards, inthe direction of arrow (D), toward an interior space defined betweencartridge (37) and anvil (18) of end effector (12). As buttress (100) isurged in the direction of arrow (D), buttress (100) will unwrap fromroll (103) so that a sufficient amount of buttress (100) is exposed fromthe retained portion of buttress (100). The exposed portion may retaintissue (90) that urges it proximally inwards into the interior space.Additionally, roll (103) could be resiliently biased to retract, toreduce inadvertent unwrapping of buttress (100).

In use, after fastener (104) is attached to anvil (18) and tissue (90)has urged buttress (100) inwards, end effector (12) will operate asdescribed above to sever and staple tissue (90) while additionallydriving staples (47) through buttress (100) and slicing through portionsof buttress (100). The effect will be to dispose portions of buttress(100) onto tissue (90). Buttress (100) may be composed of a materialincluding, for example, a hemostatic agent to assist to coagulate bloodand reduce bleeding at the severed and/or stapled surgical site alongtissue (90). In addition or in the alternative, buttress (100) maycomprise a biodegradable polymer operable to assist with tissue repairas described below. Material of buttress (100) severed by firing bar(14) may be deposited onto tissue (90). Additionally, when surgicalstaple (47) is driven into tissue by a surgical instrument, such as byinstrument (10) in the manner disclosed above, surgical staple (47) willcompress, connect, and retain such tissue as shown in FIG. 10. Materialfrom buttress (100) will contact the compressed tissue and release ontothe tissue to assist with tissue repair by reducing the amount ofbleeding at the surgical site. In addition or in the alternative,buttress (100) may provide reinforcement to the integrity of themechanical attachment of tissue (90) by staples (47). Surgical staple(47) may comprise a material selected from iron, nickel titanium alloy,stainless steel, and/or titanium. Of course, any other suitablematerials may be used.

The material for buttress (100) may comprise, for example, adjunct orhemostatic agents such as fibrin or thrombin that assist to coagulateblood and reduce the amount of bleeding at the surgical site. Thehemostatic abilities of such adjuncts may also contribute to the use ofsuch adjuncts as adhesives and sealants. The agents may assist tocoagulate blood at a surgical site which allows tissue surrounding suchblood to stick together and may prevent leaks along the stapled tissuesite, for example.

Such adjuncts or reagents may further include but are not limited tomedical fluid or buttress components. Preferred materials are natural orgenetically engineered absorbable polymers or synthetic absorbablepolymers, or mixtures thereof. Examples of natural or geneticallyengineered absorbable polymers are proteins, polysaccharides andcombinations thereof. Proteins include, prothrombin, thrombin,fibrinogen, fibrin, fibronectin, heparinase, Factor X/Xa, FactorVII/VIIa, Factor IX/IXa, Factor XI/XIa, Factor XII/XIIa, tissue factor,batroxobin, ancrod, ecarin, von Willebrand Factor, collagen, elastin,albumin, gelatin, platelet surface glycoproteins, vasopres sin,vasopressin analogs, epinephrine, selectin, procoagulant venom,plasminogen activator inhibitor, platelet activating agents, syntheticpeptides having hemostatic activity, and/or combinations thereof.Polysaccharides include, without limitation, cellulose, alkyl cellulose,e.g. methylcellulose, alkylhydroxyalkyl cellulose, hydroxyalkylcellulose, cellulose sulfate, salts of carboxymethyl cellulose,carboxymethyl cellulose, carboxyethyl cellulose, chitin, carboxymethylchitin, hyaluronic acid, salts of hyaluronic acid, alginate, alginicacid, propylene glycol alginate, glycogen, dextran, dextran sulfate,curdlan, pectin, pullulan, xanthan, chondroitin, chondroitin sulfates,carboxymethyl dextran, carboxymethyl chitosan, chitosan, heparin,heparin sulfate, heparan, heparan sulfate, dermatan sulfate, keratansulfate, carrageenans, chitosan, starch, amylose, amylopectin,poly-N-glucosamine, polymannuronic acid, polyglucuronic acidpolyguluronic acid, and derivatives of any of the above. Examples ofsynthetic absorbable polymers are aliphatic polyester polymers,copolymers, and/or combinations thereof. The aliphatic polyesters aretypically synthesized in a ring opening polymerization of monomersincluding, but not limited to, lactic acid, lactide (including L-, D-,meso and D, L mixtures), glycolic acid, glycolide, ε-caprolactone,p-dioxanone (1,4-dioxan-2-one), and trimethylene carbonate(1,3-dioxan-2-one). Other suitable compounds, materials, substances,etc., that may be used in a medical fluid or buttress will be apparentto those of ordinary skill in the art in view of the teachings herein.

In some versions, a medical fluid may be suspended in a biocompatiblecarrier to form the material of buttress (100). Suitable carriers mayinclude, for example, a physiological buffer solution, a flowable gelsolution, saline, and water. In the case of gel solutions, the tissuerepair composition may be in a flowable gel form prior to delivery atthe target site, or may form a gel and remain in place after delivery atthe target site. Flowable gel solutions may comprise one or more gellingmaterials with or without added water, saline, or a physiological buffersolution. Suitable gelling materials include biological and syntheticmaterials. Exemplary gelling materials include proteins,polysaccharides, polynucleotides, and other materials such as alginate,cross-linked alginate, poly(N-isopropylacrylamide), poly(oxyalkylene),copolymers of poly(ethylene oxide)-poly(propylene oxide), poly(vinylalcohol), polyacrylate, or monostearoyl glycerolco-Succinate/polyethylene glycol (MGSA/PEG) copolymers, and combinationsof any of the foregoing.

Buttress (100) may comprise a fibrous pad, a foam, a matrix, a mesh, oranother structure, in accordance with the teachings of, by way ofexample, U.S. Patent App. Pub. No. 2009/0120994, entitled “SurgicalFastening Device with Initiator Impregnation of a Matrix or Buttress toImprove Adhesive Application”, published May 14, 2009, issued as U.S.Pat. No. 7,708,180 on May 4, 2010, the disclosure of which isincorporated by reference herein. The material may comprise, forexample, a biocompatible material that is a buttress, a matrix having aplurality of openings therein, an open cell foam, a closed cell foam,and/or a fabric pad. The material may include porosities that induce awicking feature to drawing adhesive into the material and ensure theopenings remain clear of the adhesive, allowing tissue growth throughthe openings after application to tissue. Other suitable materials andcompositions that may be used to form buttress (100) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

III. Another Exemplary Self-Dispensing Buttress Integral with aCartridge

FIG. 8 shows another exemplary self-dispensing buttress (122) integralto cartridge (37). FIG. 8 shows buttress (122) in a position in whichbuttress (100) has been attached to anvil (18). Buttress (122) may beattached to anvil (18) in a similar manner as that described above toattach buttress (100) to anvil (18).

Buttress (122) is disposed within the body of cartridge (37), betweentop surface (124) of cartridge (37) and bottom cartridge pan (102) ofcartridge (37). Rather than being stored in a roll within cartridge(37), buttress (122) is stored in a substantially flat manner andsubstantially parallel to cartridge pan (102). Buttress (122) may bedisposed below staples (47), drivers (43), and wedge sled (41) that arecontained without the housing of cartridge (37). Buttress (122) may havea width that corresponds to or is slightly less than the width ofcartridge pan (102). Alternatively, cartridge pan (102) may be modifiedto include internal walls configured to hold a length of buttress (122),and buttress (122) may then have a width that corresponds to or isslightly less than the width of the internal walls. Buttress (122) mayalso be disposed below cartridge pan (102). Cartridge pan (102) mayinclude, for example, external walls configured to hold a length ofbuttress (122) to retain buttress (122) while allowing portions ofbuttress (122) to travel longitudinally, for example, in the directionof arrow (E) of FIG. 8. It should be understood that, in the presentexample, free end (123) of buttress (122) may travel freely within orbelow cartridge pan (102).

A portion of buttress (122) is received and urged through aperture (128)defined within top surface (124) at a distal end of cartridge (37). Inparticular, after attachment to buttress (122), anvil (18) will bedirected in the direction of arrow (E) towards an open position, asshown in FIG. 8. As anvil (18) is directed towards the initial, openposition, buttress (122) will be linearly and distally pulled in thedirection of arrow (F) and be pulled upwards in the direction of arrow(E). In particular, an end of buttress (120) is attached to a fastener,such as end (112) of buttress (100) attaches to fastener (104),described above. Similarly, a force is provided upon buttress (122) whenthe attached fastener is directed upwards in the direction of arrow (E).

As described above with respect to buttress (100), buttress (122) mayreceive a material, such as tissue (90). Buttress (122) may operate in asimilar manner as buttress (100) to extend about tissue (90) and to haveexposed portions of buttress (122) driven with staples (47) and/orfiring bar (14) onto portions of tissue (90).

IV. An Exemplary Self-Dispensing Buttress Integral with a Lower Jaw

FIG. 9 shows another exemplary self-dispensing buttress (130) in aposition in which buttress (130) has been attached to anvil (18).Buttress (130) may be attached to anvil (18) in a similar manner as thatdescribed above to attach buttresses (100, 122) to anvil (18). Buttress(130) is disposed between cartridge pan (102) and lower jaw (16) of endeffector (12). Lower jaw (16), as described above, is configured toreceive cartridge (37). Lower jaw (16) may be configured to accommodatea removable and replaceable length of buttress (130).

Rather than being stored in a roll within cartridge (37), buttress (122)is stored in a substantially flat manner along surface (126) of lowerjaw (16) disposed opposite cartridge pan (102) when cartridge (37) isreceived within lower jaw (16). Buttress (122) may have a width thatcorresponds to or is slightly less than the width of lower jaw (16).Alternatively, lower jaw may be modified to include internal wallsconfigured to hold a length of buttress (130), such that buttress (130)may have a width that corresponds to or is slightly less than the widthof the internal walls.

When cartridge (37) is received within lower jaw (16) and on top ofbuttress (130), a sufficient space exists such that buttress (130) maybe pulled linearly and distally the direction of arrow (G) and be urgedaround distal end (132) of cartridge (37). Tissue (90) wrapped bybuttress (130) moves proximally inwards in the direction of arrow (H) ina manner similar to that described above for buttresses (100, 122), asopened end effector (12) is advanced over tissue (90) to “bite” tissue(90).

As described above with respect to buttress (100), and as shown in FIG.10, buttress (130) may receive a material, such as tissue (90). Buttress(130) may operate in a similar manner as buttress (100) to extend abouttissue (90) and to have exposed portions of buttress (122) driven withstaples (47) and/or firing bar (14) onto portions of tissue (90).

FIG. 11 shows an example of using end effector (12) to apply one of theexemplary buttresses (100, 122, 130) described herein onto tissue (90)to deposit tissue repair composition (132) onto tissue (90). After suchan application as described above, tissue repair composition (132) ofand released by the respective buttress (100, 122, 130) substantiallysurrounds and is coated onto staples (47) that compress layers of tissue(90).

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures.

Versions of described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by a userimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various versions in the present disclosure,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, versions, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

We claim:
 1. A surgical instrument, comprising: (a) a body; (b) a shafthousing a firing bar; (c) an end effector comprising an anvil, a lowerjaw, and a stapling and severing assembly responsive to a longitudinalclosing motion produced by the body and the shaft; (d) a removablecartridge, wherein the lower jaw is configured to receive a cartridgewhen the end effector is in an open configuration, the cartridgecomprising: (i) a housing, (ii) a plurality of staples disposed in thehousing, and (iii) a deck disposed over the plurality of staples, thedeck defining apertures, each aperture being substantially disposed overeach staple; and (e) a movable buttress that is integral with thehousing of the cartridge or integral with the lower jaw of the endeffector, wherein the buttress is disposed in a roll within the housingof the cartridge, the buttress being movable relative to the cartridgeand relative to the end effector.
 2. The surgical instrument of claim 1,wherein the roll is resiliently biased.
 3. The surgical instrument ofclaim 1, wherein the buttress is disposed in a substantially flatposition within the housing of the cartridge.
 4. The surgical instrumentof claim 3, wherein a free end of the buttress is configured to travelfreely within the housing of the cartridge.
 5. The surgical instrumentof claim 1, wherein the housing of the cartridge comprises a cartridgepan, wherein the cartridge pan is configured to receive the buttress ina substantially flat position.
 6. The surgical instrument of claim 1,the housing of the cartridge comprises a cartridge pan, wherein thebuttress is disposed in a substantially flat position on an exterior,underside surface of the cartridge pan.
 7. The surgical instrument ofclaim 1, wherein the housing of the cartridge comprises a cartridge pan,wherein an underside of the cartridge pan includes exterior walls,wherein the exterior walls are configured to receive the buttress in asubstantially flat position.
 8. The surgical instrument of claim 1,wherein the buttress is disposed in a substantially flat position alongan interior surface of the lower jaw of the end effector, wherein theinterior surface is configured to receive the removable cartridge. 9.The surgical instrument of claim 1, wherein the lower jaw of the endeffector comprises interior walls, wherein the interior walls areconfigured to receive the removable cartridge, wherein the interiorwalls are further configured to receive the buttress in a substantiallyflat position.
 10. The surgical instrument of claim 1, wherein an end ofthe buttress comprises a fastener.
 11. The surgical instrument of claim10, wherein a distal end of the anvil defines an opening configured toreceive the fastener of the buttress.
 12. The surgical instrument ofclaim 1, wherein the buttress comprises a biocompatible materialselected from a group consisting of at least one of the followingmaterials: epsilon-caprolactone glycolide, bovine pericardium,polylactic acid, polyglycolic acid, polyglactin, polydioxanone,polyglyconate, whey protein, cellulose gum, starch, gelatin, silk,nylon, polypropylene, braided polyester, polybutester, polyethylene, andpolyetheretherketones.
 13. The surgical instrument of claim 1, whereinthe buttress comprises one of fibrin or thrombin.
 14. The surgicalinstrument of claim 1, wherein the buttress is configured to providereinforcement to the mechanical integrity of the staples when thestaples are driven through the buttress and towards the anvil.
 15. Asurgical instrument, comprising: (a) a body; (b) a shaft housing afiring bar; (c) an end effector comprising an anvil, a lower jaw, and astapling and severing assembly responsive to a longitudinal closingmotion produced by the body and the shaft; (d) a removable cartridge,wherein the lower jaw is configured to receive a cartridge when the endeffector is in an open configuration, the cartridge comprising: (i) ahousing, (ii) a plurality of staples disposed in the housing, and (iii)a deck disposed over the plurality of staples, the deck definingapertures, each aperture being substantially disposed over each staple;and (e) a movable buttress that is integral with the housing of thecartridge or integral with the lower jaw of the end effector, thebuttress being movable relative to the cartridge and relative to the endeffector, wherein an end of the buttress comprises a fastener, wherein adistal end of the anvil defines an opening configured to receive thefastener of the buttress.